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NEW YORK, April 26 (UPI) -- Anyone in this country who watches television probably knows about the skin condition psoriasis, and voluminous commercials that tout prescription drug treatments for the autoimmune disease may be fueling a rise in diagnoses, experts say. These advertisements reflect some of the 70 medications approved by the Food and Drug Administration to manage the disease, with social media influencers touting many of them online.
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Marketing efforts may prompt some self-diagnosis of the disease in the United States -- the country accounts for 8% of all cases of the disease globally, or twice its share of the world population, according to Persistence Market Research.
But the symptoms are all too real.
"There is a lot of concern about the influence of commercials from drug companies because we are seeing that increased patient awareness of the disease has led to a rise in diagnoses," dermatologist Dr. Jun Lu told UPI in a phone interview.
"In places like Europe, drug companies aren't allowed to advertise in this way, and it may be why fewer people are being diagnosed with psoriasis," said Lu, an associate professor of dermatology at UConn Health in Farmington, Conn.
Psoriasis by the numbers
An estimated 125 million people worldwide, or 2% of the global population, has psoriasis, which causes plaques, or itchy, sore patches of thick, dry, discolored skin according to the World Health Organization.
That the United States' share of cases of the disease is among the highest worldwide is reflected in sales of prescription drugs designed to treat it, according to market research firm Mordor Intelligence.
Last year, prescription drugs for psoriasis generated $24.3 billion in sales revenues, a figure that is expected to nearly double by 2031 to $47.4 billion, based on data from Fortune Business Insights.
At $10.4 billion, North America accounted for about half of worldwide psoriasis drug sales in 2021, Fortune Business Insights reports, and the United States makes up about 90% of North American sales, Mordor Intelligence estimates.
At least some of those sales are the result of widespread consumer advertising of prescription drugs, which is unique to the United States and its "for profit" healthcare system, UConn's Lu said. One company's commercial urges sufferers to get treatment and "show more of yourself."
Some drugs lead in ads
Some drug brands dominate the psoriasis advertising landscape, including AbbVie's Skyrizi, or risankizumab, and Novartis' Cosentyx, or secukinumab, according to Mordor, with the latter's commercials featuring singer-songwriter Cyndi Lauper, a psoriasis sufferer.
Other brands marketed widely are Eli Lilly's Taltz, or xekizumab, and Janssen's Tremfya, or guselkumab, Mordor said.
All of these treatments are administered in dermatologists' offices, via injections typically given every four to 12 weeks, according to information provided by the respective manufacturers.
Treatments can be expensive, with some newer medications costing up to $20,000 per dose, without insurance coverage, based on manufacturer pricing information.
Not all insurance plans cover psoriasis treatments, though some drug companies provide patients with financial assistance through coupons and other discounts, according to the National Psoriasis Foundation.
Because they are "systemic" medications that affect the function of the immune system, they can have serious side effects, including an increased risk for infections, Lu said.
As a result, she and her colleagues limit their use to patients who have severe symptoms, such as widespread plaques covering large areas of their skin, and those who have progressed to psoriatic arthritis, a related disease that causes joint pain similar to other forms of arthritis, she said.
"Physicians don't prescribe these drugs just because patients think they have psoriasis after seeing a commercial on television," Lu said. "They only prescribe them after making a formal diagnosis."
Other health woes
A sign that there is more behind psoriasis than skin symptoms seen in commercials is that those with the disease typically have other health problems, an indication that the inflammation behind it may have other negative affects, according to Lu.
For example, people with Type 2 diabetes appear to be at higher risk for psoriasis, and vice versa, research suggests.
Similarly, obesity, or being severely overweight, appears to cause widespread inflammation in the body and increase the risk for psoriasis, Lu said.
The inflammation behind psoriasis also has been linked to an increased risk for heart disease among those with the disease, said Dr. Ladan Mostaghimi, an emeritus professor of psychiatry at the University of Wisconsin-Madison, who treats patients with psoriasis.
"That's why we really emphasize a holistic approach to treatment that includes not only prescription treatments, but lifestyle things like diet and exercise as well," Lu said.
"Some physicians may rush to prescribe a drug, and that may help, but we need to treat the underlying causes of the disease," she said.
Painful history
Many people's first exposure to psoriasis may be through television commercials, but the disease's history actually traces back more than 1,200 years and has significant health implications for sufferers, according to Mostaghimi, who specializes in the field of psycho-dermatology.
For example, the anxiety surrounding the outward symptoms affecting the skin -- when plaques are on parts of the body visible to others -- can lead to mental health complications, including depression, she said.
This may be why people with psoriasis may be at increased risk for suicide compared with the general population, research suggests, creating the need for the field of "psycho-dermatology," or mental health services focused on those with skin conditions, Mostaghimi said.
"It is more than stigma or cosmetic factors alone -- we have a combination of biological and psychological factors that interact closely and cause emotional effects," Mostaghimi, who in addition to who work has studied the history of psoriasis, told UPI in an email.
"Even though visible lesions could cause more distress, psoriasis also causes systemic inflammation, as well as arthritis, and metabolic syndrome, and these result in emotional distress, pain, and limitation in daily activities," she said.
Fingernails affected
Up to 70% of people with psoriasis have plaques that affect their fingernails, a visible symptom causing discoloration and cracking, and nearly 30% progress to painful psoriatic arthritis, according to the National Psoriasis Foundation.
In other words, the condition is more than skin deep -- in spite of the focus on skin seen in television commercials, another psycho-dermatologist, Dr. Mohammad Jafferany, told UPI in an email.
"The drug manufacturers and drug commercials should also focus on other symptoms such as itching in the lesions, and pain," said Jafferany, a clinical professor of psychodermatology at Central Michigan University in Saginaw.
"That's why the holistic approach toward psoriasis is advocated, including not only treating visible disease but also helping associated itch, pain and anxiety and depression associated with psoriasis," he said.
